Monday, April 03, 2017

HEALTH CARE IN AMERICA - Affordable Care Act Marketplaces

"Did Obamacare help or hurt you?" by Jason Kane, Laura Santhanam, and Matt Ehrichs; PBS NewsHour Updated 3/27/2017


Capitol Hill is still embroiled in a debate about the cost of health care, who should pay for it and how.  And Americans across the country have been having that debate — who gets covered, which physician they can see and how much they should pay — almost every day for years now, since Congress passed President Barack Obama’s signature health care law in 2010.

Last week, the House Republican plan to repeal and replace the Affordable Care Act failed to earn enough support for lawmakers to vote on the law, the American Health Care Act.

“Obamacare is the law of the land,” House Speaker Paul Ryan said after the latest reform effort failed.  “It’s going to remain the law of the land until it’s replaced.  We did not have quite the votes to replace this law.  And so, yes, we’re going to be living with Obamacare for the foreseeable future.”

More than half of U.S. adults approve of the Affordable Care Act, according to a national survey from Pew Research Center, but those opinions quickly split along political party lines.

The PBS NewsHour asked people if they were concerned or encouraged by possible, future changes to the Affordable Care Act.  More than 1,000 people responded from across the country — from Maine to Missouri and California.

These are a few of those stories.


AGE:  41
LOCATION:  Wichita Falls, Texas
OCCUPATION:  Car and house insurance agent

Jennifer Cartwright knew something was wrong when her 2-year-old son’s stomach swelled up like a balloon.  Doctors later removed a fast-growing, softball-sized cancerous tumor — a rhabdomyosarcoma.  The Affordable Care Act went into effect just as her son, Zach, entered a year of treatment, including radiation “that just fried his insides” below his lungs and above his knees.  He was left scarred and could only eat through a tube, but he survived.  Today, he loves to play video games, especially Mario Brothers and Lego Dimensions, and will celebrate his 10th birthday this June.

Annually, his medical bills for hospital visits and a dozen medications add up to as much as $100,000, which — in a good year — equals Cartwright’s entire full-time income selling car and house insurance.  But Zach’s parents haven’t worried about him hitting a lifetime cap on insurance coverage because Obamacare abolished that practice, Cartwright said.  To defray costs, she enrolled Zach into Medicaid, but she said Texas tightened access to Medicaid services and has rejected care Zach receives since November: “They just made everything harder.  Everything needs pre-authorization.”

A lifelong Republican, Cartwright sees both sides of the health care debate that has embroiled the nation.  She said she agrees the nation overspends on health care and must cut costs, “but where?” she asked.  State policymakers and insurers don’t want to make life harder for pediatric cancer patients and their parents, she said, but “they don’t realize how delicate a balance it is, and now it’s out of whack.”

“I’m in this catch-22.  I understand insurance.  I understand it’s a business.  It’s for-profit,” she said.  “But I also see it from the personal side.  Here I am in the middle of it all.”


AGE:  50
LOCATION:  Greensboro, North Carolina
OCCUPATION:  Veterinarian

When Timothy Tribbett first became a veterinarian two decades ago, he said his health insurance was “super affordable” at $125 each month.  But now, that price has quadrupled, and Tribbett grows angry when he talks about how he must pay more than his mortgage payment to stay insured.

After the Affordable Care Act passed, Tribbett said the small veterinary practice where he and 17 other people work announced they would no longer cover employee health insurance, and none of them qualified for subsidies to ease the burden.  Tribbett, 50, said he blames Obamacare for driving all but one insurance company out of his community.  Most North Carolina residents who buy marketplace insurance have only one option this year, NPR reported.  Tribbett would rather see high-risk pools set up for the uninsured (“don’t take money out of my pocket”) and plans offered across state lines to encourage “some competition.” The latter is something not included in the current version of the American Health Care Act, but it’s been discussed as something that could be part of future phases of Republican health care reform.

“If you work for a small company, and you have to get it on your own, you are absolutely screwed,” he said.  “I can’t chance going without it right now, but if it keeps going up, I just can’t afford it.”

In the past, Tribbett has taken medication for OCD and chronic neck pain, but he avoids going to the doctor to get prescription refills because his deductible for each visit is too high, he said.

While his premiums climb, Tribbett said he’s also trying to save some of his $75,000 annual income for retirement.  He hopes to move back to his family’s 100-acre farm, nestled in the Blue Ridge Mountains near Roanoke, Virginia.  But at this rate, Tribbett thinks he’ll be 70 before he can afford to stop working.

“I’m not looking forward to working another 20 years,” he said.

Tribbett thinks the Republican health care plan moving through Congress is a “step in the right direction.”  He supports proposed tax credits “for middle class people like me that have to buy their own insurance without subsidies,” and while conservative groups have criticized parts of the House Speaker Paul Ryan’s plan, Tribbett said “hopefully, those concerns will be addressed.”


AGE:  50
LOCATION:  Shreveport, Louisiana
OCCUPATION:  Currently unemployed auditor

Medicaid patient to GOP: ‘You’re signing my death sentence’
More than 11 million adults — like Julia Raye of Louisiana — gained health insurance through the Affordable Care Act’s expansion of the Medicaid program.  But under the Republican plan to replace the ACA, Raye, an unemployed diabetic who will be starting a new job in the coming weeks, may be barred from reentering a much more restrictive Medicaid program in the future if she once again falls on hard times.  Going without insurance and appropriate medications would be disastrous for her health, she says.  “If you don’t think that Medicaid is important, then you’re signing my death sentence,” Raye said to the congressional leaders deciding the fate of the ACA.  “If you’re comfortable with that, then go right ahead.”


AGE:  31
LOCATION:  Fairmont, West Virginia
OCCUPATION:  Health insurance counselor for West Virginia Medicaid

Mina Schultz’s life was ready for launch.  She had just earned her master’s degree in French from the University of Missouri in 2011 and wanted to join the Peace Corps.  At age 25, she planned to go without insurance for a few months, but Schultz’s father took advantage of a then-new Obamacare provision that allowed him to add her to his insurance.  Then her right knee began to ache and swell.  She iced it for six weeks, and doctors suggested the avid runner give her hobby a break to let her condition improve, but her knee only got worse.  She went for an MRI scan, covered by insurance.

“I joked with the technicians, ‘Did you see anything good in there?’  They said, ‘Yeah, you’ll be glad you came in.’ I thought, 'Ok, I must have torn something'”

Schultz had osteosarcoma, a rare bone cancer normally found in children.  She still chokes up when she remembers the moment she learned she had cancer.  A year later, doctors replaced her knee (half of her right leg is titanium), and she entered an Affordable Care Act health exchange for insurance while in remission.  After purchasing an ACA plan, Schultz joined the effort to sign up more enrollees.  In October 2014, she found a job at a community health center near her mother’s home in Fairmont, West Virginia, enrolling hundreds of West Virginians in the health insurance marketplace and onto Medicaid.

In December, Schultz said new enrollees streamed into her office, but after President Donald Trump’s inauguration, they’d scoff at the prices for coverage.  She said they told her: "‘Trump is going to fix this.  I only need this for a few months and then this will go away and it’ll be cheaper.’"

“People want the health insurance, they just don’t want huge deductibles and huge premiums,” she said.

With Obamacare, Schultz said her family avoided bankruptcy and she “can afford care despite a preexisting condition.”  She said she’s terrified the exchanges may go away.  Insurance companies decide in May which marketplaces they will commit to in 2018 and how much they will charge, but Schultz worried insurers may balk over uncertainty about Obamacare’s fate, raising insurance prices even more.

“They already went up too much this year,” she said.  “I worry that people are going to drop out because they can’t afford it.”


AGE:  54
LOCATION:  Indianapolis, Indiana
OCCUPATION:  Marketing

When Kourtnaye Sturgeon cooks dinner, her thoughts drift to her older son, his hard-fought battle against his heroin addiction and how close he came to death.

The summer after her son Ryan graduated high school, Sturgeon learned about his drug use.  When she confronted him (“with love, not anger”), Sturgeon said, “he broke down.”

Her son went in and out of treatment, including detox, counseling and taking suboxone, but his addiction’s hold was strong.  He dropped out of college in summer 2010 and lost his job at a pasta restaurant.  He not only stole from her, Sturgeon said, but also shoplifted meat from grocery delis and resold it to buy drugs and further fuel his addiction.

Finally, Sturgeon added him to her insurance in January 2011 under Obamacare.  Her son ended up in a 90-day inpatient treatment with 60-day intensive outpatient care and counseling, all covered by Sturgeon’s insurance.  He has since entered recovery, and this July, now 25 years old, he looks forward to celebrating three years of sobriety, Sturgeon said.

“I know my son would not have survived his illness.  I feel very blessed, but I also carry a bit of guilt,” she said.  “I’ve met so many parents who have lost their children to overdose.”

Sturgeon said she knows he is in continuous recovery and that “with this chronic disease, relapse is likely,” she said.  “But he has learned so much along the way from the benefit of really high quality treatment to help carry him through the relapse back health recovery.”

The Trump administration unveiled its proposed budget earlier this month.  It’s unclear which agency will take the lead on a national strategy to combat opioids, a job the White House Office on National Drug Control Policy has held for three decades.  The Trump budget eliminates that office altogether.

Sturgeon’s son is not alone, Sturgeon said, and neither is she.  At a time when an estimated 20 million Americans live with substance addiction, Sturgeon said it is important to make treatment accessible to combat this “complex disease.”

There is more.

"How healthy are the Affordable Care Act marketplaces?" PBS NewsHour 3/27/2017


SUMMARY:  The Affordable Care Act withstood a Republican effort to "repeal and replace," but there are problems with the current law that lawmakers acknowledge need to be addressed.  We meet a few Americans who have concerns about Obamacare.  Then Mary Agnes Carey of Kaiser Health News joins Lisa Desjardins to discuss why affordability is an issue for some.

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